To medical students: We’re all in the same boat

I am an imposter in a white coat. I’m not sure if anyone knows yet, I hope I am good at hiding it. It’s a well-kept secret amongst all medical students. In the hospital, I am at the bottom. I know the least and have the least power. Most patients don’t realize this and look up to me like I’m an all-knowing, wise muse or something of that nature. Sometimes, I seem to play it off well. I fooled them all! They think I’m actually smart! Then the attending asks me a basic question during rounds, and I’m back at baseline thinking I’m stupid and incompetent once again.

This is a cycle medical students experience once they get to the wards. We put on the short white coat that we were once so proud to wear on the day we matriculated into medical school. Now, after completing most of my clinical rotations, I find every excuse not to wear it. It’s not just because I always seem to spill a drop of coffee onto my sleeve every damn morning (of all colors, why white?), but also because I literally feel like I don’t deserve to wear something that presumes such greatness and authority. With it carries a huge responsibility, and I just don’t want to disappoint. Heaven forbids a medical student being a disappointment to society. We’d rather get hemorrhoids and drown in our own blood from our anus.

Every medical student is pretending to be smarter than they are and less stressed than they really are. We study way more than we claim we are, have much less fun than we brag about on Facebook, and are much more insecure than we put ourselves out to be. I know this to be true because I am guilty of this. I’ve been faking it till I make it since the beginning of time. It’s contagious, and it’s toxic.

Why do we put ourselves through this misery? For me, it’s because I have these unrealistic expectations of perfection. We’re a unique group of people, chosen from the top of our class from an elite group of students from each college. We’re used to achieving and striving to be the best at what we do, whether it’s academics, music, sports, art, or drinking. When you put a group of similar high-achieving, neurotic people together, you raise the bar exponentially, as well as individual expectations and competition. Our sense of self-worth, confidence, and thus degree of happiness then plummets. The medical school environment does not alleviate this disastrous outcome, especially since the root cause is us, the students.

It’s not really our fault either. From the beginning, we have been drilled to succeed and rewarded for our academic (and non-academic) achievements. That’s how we got here to begin with. I’m sure some of us did so at the expense of someone else. Not everyone could win first place in that piano competition, be valedictorian, or captain of the soccer team. Some of us are so used to success, that we don’t know how to handle failure. In medical school, many of us experienced our first failures, and many don’t know how to cope with that. We forget what made us truly happy, and why we came to medical school in the first place. It’s easy to get lost in our self-destructive thoughts: “I’m not good enough for this. I don’t deserve to be here. Why is (insert name) so much better at biochem than me? Why did (insert name) get a higher USMLE Step 1 score than me even though I studied so much longer? How come (insert name) has time to publish all these research papers, when I don’t have any? …”

You can tell how vicious this process of thinking can get. I know, because I have been through this.

To provide a sense of comfort to other medical students who feel the same as me, you’re not alone. I’m just as insecure about my abilities as the rest of you despite my determined attempts at hiding it. I hope that one day, this will all be behind me and I will truly be a competent physician who doesn’t have to pretend anymore. I hope that I will stop comparing myself to other “more competent” people who seem to have everything put together. I sincerely make an effort to try to only compete with myself, but some people make that extremely difficult when they are advertising their 250s in public and posting their publications and other vast achievements on social media. (And even after I get rid of Facebook, somehow I still hear about it.)

I genuinely try to feel happy for them, and part of me truly is proud, but there’s always this other side of me that feels jealously and shame towards myself — a nagging voice asking, “Why couldn’t that be you?”

I know I can’t avoid all of this thinking process completely, but I have taken steps to at least calm the waves down. I focus on the positive things in my life and have stopped placing unrealistic expectations on myself. I hang out with similar-minded people who make me happy and don’t patronize others. I reconnect with my old friends who I have seemingly ignored for the past three years. I rediscover the real things in life that make me happy — family, friends, my dog, nature, Ellen Degeneres, and wine.

Don’t get me wrong, I still study my ass off, but am not obsessed about it anymore. When I put on my white coat, I think about how privileged I am to have this incredible and rare opportunity to do so. Instead of feeling stupid after not knowing an answer, I think of it as a positive learning experience — why would I even be here if I knew all the answers anyway? I try to avoid people who can’t stop talking about how many clerkships they honored, how many clinics they started in a third world country, and how many attendings are so impressed by their knowledge of the purine synthesis pathway. I’ll be friends with them once they get over their own insecurities and stop having to constantly prove how “good” they are.

We’re all in the same boat here. Let’s keep the sea as calm as possible until we land.

Physician Coaching by KevinMD

To medical students: We’re all in the same boat 7 comments

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SteveCaley

But realize this – you are the only Serena Zhou in the room. That’s all you will ever be, so try to be the best Dr. Zhou that you can.

If B.S. could be converted into energy, we could tap all the teaching hospitals, and get rid of our dependence on fossil fuels-Don’t sweat it.

It took me YEARS to get stupid enough to be a good doctor. Now, when a patient comes in to clinic with only one leg, I ask – “what happened to your leg?” It took my YEARS of contemplation to understand how to ask that question. Or, “What’s wrong with your eye?” In the VA, “Those your teeth, or store-bought?”

Sometimes, only the fools get the honest answers. Now, I ask the patient, “What do YOU think is going on? Does that explanation make sense to you? Do you think we’re taking you seriously? Do YOU think the medicine is working for you?” You don’t learn how to ask patients questions like that in most teaching rounds. The fear of looking stupid outweighs the care of the patient.

Serena Zhou

“It took me YEARS to get stupid enough to be a good doctor.” -haha I liked that one

You know what’s interesting, in the first 2 years of med school we become experts at patient-centered interviewing, especially asking the questions that you pointed out in your last paragraph. However, I noticed that as doctors-to-be progress in their careers, many start losing that “patient-centeredness” and move directly to asking direct yes/no questions. There are so many time constraints, so many other patients to see and paperwork to fill out. 3rd year of med school is also the year that medical students lose the most of their empathy. I’m beginning to see why. I’ve actually been told that I “care too much” about my patients or that I was too “friendly,” almost like it was a negative attribute. In response I said, “Thank you” 🙂 I’m not as naive as I used to be before going into this field, but I have core values that define who I am, and I pray I will never lose sight of those values and why I am here in the first place.

SteveCaley

Make sure to practice the patient-centeredness, although you do not get a good grade for it. It has been my “downfall” on the way to “success,” as I am often told I am very “slow.” I find that I am slow, because I clean up the messes that the fast doctors make.
Do not confuse inhumane nonsense with caring. Especially in residency – there are so few that respect humanity.
You can be excellent on your own terms, if you remain a human being. Please do so.

Serena Zhou

I totally agree! Building the mutually trusting relationship with the patients makes it all worth it, and I wouldn’t trade it for anything in the world (except maybe Anthony Bourdain’s job). It definitely depends on the rotation, some are a bit harsher than others, but overall it really does come down to the patients, and if I keep that in mind it makes even the worse days so much better 🙂

Zach Jarou

Totally true: “Some of us are so used to success, that we don’t know how to handle failure.” Excellent reflection Serena!

Dr. Cap

You don’t see it now, and this might sound horrifying because you cannot see past the microcosm of the step scores, but I will tell you anyway:

That feeling evolves, but never goes away. But that’s a good thing. It keeps us motivated to be better, to keep learning. Not a day goes by as an attending that I don’t stop and acknowledge that I do care what my colleagues think of me, that I will bust my hump so they don’t think I’m stupid or inferior.

The difference is now at this point, I know for a fact that I’m not.

Serena Zhou

Thanks for your comment JW – it’s people like you that keeps me motivated, inspired, and excited to come to work every day 🙂